Researchers Link ICD-10 Shift to Financial Losses
The transition from ICD-9 to ICD-10 coding led to significant information loss at one oncology clinic, says a researcher who found that 39 ICD-9-CM codes with information loss accounted for 2.9% of total Medicaid reimbursements and 5.3% of the organization's billing charges.
Neeta Venepalli, MD
UIC Assistant Professor of Hematology/Oncology
Healthcare providers will see clinical and billing information and financial losses during the mandated switch to ICD-10 disease classification set later this year, a new study suggests.
The University of Illinois at Chicago study, published this month in the Journal of Oncology Practice, looked at entry ambiguities for hematology-oncology diagnoses in anticipation of the challenges providers may face during the transition from ICD-9-CM to ICD-10-CM, which takes effect on Oct. 1. UIC researchers focused on hematology-oncology because it has fewer ICD-10 codes and less convoluted mappings when compared with other sub-specialties.
The study used 2010 Illinois Medicaid data to identify ICD-9-CM outpatient codes and the associated reimbursements used by hematology-oncology physicians. Researchers identified 120 codes with the highest reimbursement for analysis. They also looked at ICD-9-CM outpatient diagnosis codes and associated billing charges used by University of Illinois Cancer Center physicians from 2010 to 2012 and selected the 100 most-used codes, the study said.
Using a web-based conversion tool developed at UIC, the ICD-9 codes were entered and translated into ICD-10 codes. Researchers looked at whether the translation made sense, whether a loss of clinical information occurred, and whether a loss of information had financial implications.
"What we found was the transition from ICD-9 to ICD-10 led to significant information loss, affecting about 8% of the Medicaid codes and 1% of the codes in our cancer clinic," said Neeta Venepalli, MD, UIC assistant professor of hematology/oncology and lead author of the study.
Researchers found that 39 ICD-9-CM codes with information loss accounted for 2.9% of total Medicaid reimbursements and 5.3% of UI Cancer Center billing charges.
Venepalli and study co-author Andrew Boyd, an assistant professor in biomedical and health information sciences at UIC, spoke with HealthLeaders Media about the findings and what providers can do to prepare for Oct. 1. The following is an edited transcript.